Work

Multicenter cohort of necrotizing enterocolitis in Latin America: evaluation of risk factors and clinical outcomes in Chilean Hospitals

Year: 2026

Type: article

Abstract: Background Necrotizing enterocolitis (NEC) remains a leading cause of neonatal morbidity. While risk factors are well documented in high-income countries, data from Latin American cohorts remain limited. Objective We aimed to identify local predictors and clinical outcomes associated with NEC in two Chilean NICUs. Methods A prospective multicenter cohort study (2017–2018) included newborns ≤32 weeks and/or ≤1,500 g. NEC (Bell stage ≥ IIA) was verified by a multidisciplinary team. Clinical and laboratory variables were analyzed using bivariate and multivariable penalized models to identify predictors of NEC and mortality. Results Among 177 newborns (mean GA 29.1 ± 3.0 weeks; BW 1,252 ± 448 g), NEC incidence was 7.9% ( n = 14). In bivariate analysis, invasive mechanical ventilation (RR = 4.58; p = 0.02) and indomethacin (RR = 3.13; p = 0.04) were associated with NEC. In multivariable models, formula feeding was the most consistent predictor (OR = 2.69 vs. exclusive breast milk), though not statistically significant. Half of NEC cases (50%) were Bell stage IIIB. Surgery was required in 38.5% of cases (all stage IIIB; p = 0.009). Case fatality among NEC patients was 40%, associated with Bell stage IIIB ( p = 0.048) and systemic shock ( p = 0.048). Conclusion Formula feeding was a consistent, though non-significant, predictor of NEC in multivariable analysis; the limited number of NEC cases ( n = 14) precludes definitive causal inference. Exclusive breastfeeding remained the most protective feeding strategy, consistent with prior literature. Disease outcomes were driven by progression to Bell stage IIIB, and early monitoring of inflammatory and metabolic biomarkers may help identify infants at risk of progression to surgical NEC.

Source: Frontiers in Pediatrics

DOI: 10.3389/fped.2026.1877057